NCPDP Universal Patient Identifier Guidance Document
Universal Patient Identifier Guidance Document
Version 1.1
This document provides guidance on the possible use of a universal patient identifier(s) within the NCPDP
Standards.
October 2020
National Council for Prescription Drug Programs
9240 East Raintree Drive
Scottsdale, AZ 85260
Phone: (480) 477-1000
Fax: (480) 767-1042
E-mail: ncpdp@
Universal Patient Identifier Guidance Document
Version 1.1
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Published by:
National Council for Prescription Drug Programs
Publication History:
Version 1.0 July 2019
Version 1.1 October 2020
Copyright ? 2020
All rights reserved.
Universal Patient Identifier Guidance Document
TABLE OF CONTENTS
Disclaimer ......................................................................................................................................... 4
1.
Executive Summary ..................................................................................................................... 5
2.
Purpose ...................................................................................................................................... 6
3.
Definitions .................................................................................................................................. 7
4.
High Level Flow ........................................................................................................................... 8
4.1 Actors ....................................................................................................................................... 8
5.
NCPDP Standards ...................................................................................................................... 10
6.
Use Cases.................................................................................................................................. 15
6.1 Both Submitter and Receiver use the same Enumerating Entity for a UPI.................................. 15
6.2 Submitter and Receiver Use the Same Two Enumerating Entities ............................................. 17
6.3 The submitter and the receiver use two enumerating entities of which one is shared ............... 20
6.4 Submitter and Receiver Use Two Different Enumerating Entities .............................................. 20
7.
Recommendations .................................................................................................................... 22
8.
Conclusion ................................................................................................................................ 23
9.
Frequently Asked Questions ...................................................................................................... 24
10. Appendix A. History of Changes ................................................................................................. 25
Version 1.1
October 2020
***OFFICIAL RELEASE***
National Council for Prescription Drug Programs, Inc.
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Universal Patient Identifier Guidance Document
Disclaimer
This document is Copyright ? 2020 by the National Council for Prescription Drug Programs (NCPDP). It
may be freely redistributed in its entirety provided this copyright notice is not removed. It may not be
sold for profit or used in commercial documents without the written permission of the copyright
holders. This document is provided ¡°as is¡± without any expressed or implied warranty.
While all information in this document is believed to be correct at the time of writing, this document is
for educational purposes only and does not purport to provide legal advice. If you require legal advice,
you should consult with an attorney. The information provided here is for reference use only and does
not constitute the rendering of legal, financial or other professional advice or recommendations by
NCPDP.
The existence of a link or organizational reference in any of the following materials should not be
assumed as an endorsement by NCPDP.
The writers of this paper will review and possibly update their recommendations should any significant
changes occur.
This document is for Education and Awareness Use Only.
Version 1.1
October 2020
***OFFICIAL RELEASE***
National Council for Prescription Drug Programs, Inc.
4
Universal Patient Identifier Guidance Document
1. Executive Summary
Proper identification of a patient is critical to many communications in healthcare. Today, stakeholders
communicate the identity of the patient in a variety of ways that can result in record duplication and/or
mistaken identity. Misidentification of a patient has been shown to lead to errors or inadequate care for the
patient1. NCPDP has identified the need for proper identification of the patient as a means to improve patient
safety and ensure positive patient outcomes.
A universal patient identifier (UPI) uniquely identifies a person for purposes of healthcare operations. An
ideal UPI would be assigned at birth, stay with a patient for their entire lifetime and never be used for any
other patient. It enables providers and other stakeholders to act on behalf of a patient with assurance that
relevant information about a patient is collected, and it enables healthcare providers to communicate about
patients with greater certainty about the identity of each patient being served.
When trading partners communicate with a UPI, the receiver can more accurately identify the patient.
Because the receiver is better able to accurately identify the patient, the occurrence of transactions being
associated to the wrong patient is lowered, clinical outcomes are improved and transactions being rejected
are reduced.
As a result of this initiative, many NCPDP standards have been updated to allow usage of a UPI so trading
partners can more precisely communicate who each patient is.
1
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